Reimbursement of Maryland Chronic Hospitals. In-State chronic hospitals shall be reimbursed according to: Rates approved by the HSCRC pursuant to COMAR 10.37.03; or The administrative day rate as follows: For a participant who is not ventilator-dependent, payment for approved administrative days shall be the estimated Statewide average Medicaid nursing facility payment rate as determined by the Department; and For a participant who is ventilator-dependent, payment for approved administrative days shall be the estimated average Medicaid nursing facility payment rate for ventilator-dependent residents as determined by the Department. State-operated chronic hospitals shall be reimbursed according to Regulation .10 of this chapter. The Department shall make no direct reimbursement to any State-operated chronic hospital. Reimbursement of Out-of-State Hospitals. The Department shall reimburse an out-of-State hospital that provides a level of service equivalent to that provided at a chronic hospital only if: The proposed admission is first reviewed by the Department or its designee and the out-of-State placement is determined medically necessary according to Regulation .07A of this chapter; The hospital possesses the same certifications and accreditations as the Program requires for a comparable level of services and specific program in a Maryland chronic hospital; and The hospital meets one of the following conditions: The hospital proposes to provide a service or specific treatment that the participant cannot obtain in a Maryland chronic hospital; or The hospital is located geographically closer to the established residence of the participant than a Maryland chronic hospital. The Department shall reimburse an out-of-State hospital at the lesser of: The average rate established by the HSCRC for an equivalent cost center for a Maryland chronic hospital; or The rate charged by the out-of-State hospital pursuant to 42 CFR Part 412, Subpart O.